Transition to retirement and risk of cardiovascular disease: Prospective analysis of the US health and retirement study

Abstract

Transitioning from work to retirement could be either beneficial or harmful for health. We investigated the association between transition to retirement and risk of stroke and myocardial infarction (MI). We followed US Health and Retirement Study participants age 50+ working full-time for pay and free of major cardiovascular disease (n = 5422) in 1998 up to 10 years for transition to full retirement and self- or proxy-report of either stroke or MI (CVD; 665 events). We used discrete-time survival analysis to compare the CVD incidence for the fully retired versus the full-time working population. To distinguish short-term from long-term risks, we compared the association in the first year after retirement to estimates 2+ years after retirement.

In the full model adjusting for age, sex, childhood and adult SES, behavior, and co-morbidities, being retired was associated with elevated odds of CVD onset (OR = 1.40, 95% CI: 1.04, 1.90) compared to those remaining in the full-time labor force. The odds ratio for CVD incidence within the first year of retirement was 1.55 (95% CI: 1.03, 2.33). From the second year post-retirement and thereafter, the retired had marginally elevated risk of CVD compared to those still working (OR = 1.35; 95% CI: 0.96, 1.91). Although confidence intervals were wide for some sub-groups, there were no significant interactions by sex or socioeconomic status. Results suggest that CVD risk is increased after retirement.

Introduction

Americans now spend more years in retirement than ever before. A major wave of retirement started in 2011, when the first Baby Boomers (born 1946–1964) began to turn 65 (He, Sengupta, Velkoff, & DeBarros, 2005). By 2050, the older population is projected to number 86.7 million. The average age of retirement, which has been declining since the 1950s, has once again been falling again since 1990 after having leveled off during the mid-1970s through 1980s (Gendell, 2001). With the first wave of the Baby Boomers' retirement and spiraling health care costs for the elderly, the question of how retirement affects health is of vital importance.

Theoretically, it has been argued that retirement might have either good or bad effects on cardiovascular health (Kasl & Jones, 2000). Retirement is a lifecourse transition involving environmental changes that reshape health behaviors, social interactions, and psychosocial stressors. It is also a subjective developmental and social psychological change in identity and preferences (Dannefer, 1984). However, there is little consensus about the impact of the retirement transition on health outcomes. Existing evidence is conflicting, and reverse causality is difficult to rule out because of unobserved selection into retirement.

Empirical findings on the health risks of retirement have been inconsistent, variously reporting harmful, beneficial or no effects. Some early studies suggested that being retired had no deleterious effects on either physical or psychological health (Kasl, 1980; Minkler, 1981). However, those studies often ignored the complexity of the retirement transition, including issues of timing, previous health, and quality of the job (McGoldrick & Cooper, 1988). More current literature reports contradictory findings. A recent study in France showed that retirement was associated with improved self-perceived health for those in poor work environments and those with health complaints before retirement (Westerlund et al., 2009). Another recent Swedish study used recorded purchases of anti-depressant medication to measure mental health; they found that retirement was associated with decreased anti-depressant usage (Oksanen et al., 2011). Others found adverse associations, reporting increased musculoskeletal and CVD prevalence among retired Finnish men (Tuomi, Järvinen, Eskelinen, Ilmarinen, & Klockars, 1991), and significantly elevated risk of severe cardiovascular disease or cancer onset associated with retirement in England (Behncke, 2011). There are also studies reporting no effect on physical or mental health. One study found that retirement was associated with a reduction in mental and physical fatigue and depressive symptoms, particularly among people with chronic diseases, but retirement did not change the risk of major chronic disease onset (stroke, MI and coronary heart disease) (Westerlund et al., 2010). These mixed results may be partially attributable to incomplete adjustment for differential selection into retirement, i.e., lack of comparability between retirees and those who continue to work at similar ages (Miah & Wilcox-Gök, 2007).

We investigated factors that may modify the effect of retirement on cardiovascular health, specifically risk of first stroke and myocardial infarction (MI). We hypothesized that higher individual- and family-level SES modifies the association between retirement and cardiovascular health. In this paper, we aim to address both reverse causation and effect modification by exploiting the extensive set of measures available in a nationally representative sample of Americans transitioning into retirement.